"Medicare for all" has to be for all

October 2, 2017

IN RESPONSE to "What's the next step toward Medicare for All?": One next step in the struggle for Medicare for all must be to organize for a fully funded, high-quality, equitable long-term program as part of Medicare for All, and that this program must respect the disability rights slogan, "Nothing about us without us."

Sean Petty doesn't mention the fact that S 1804, the "Medicare for All Act of 2017," treats long-term care differently than all other health care, leaving it to the states and to Medicaid. HR 676, John Conyers' "Expanded and Improved Medicare for All Act," includes long-term care and specifies, consistent with the Disability Integration Act designed to protect the civil rights of people with disabilities, a preference for home- and community-based services over institutionalization.

S 1804 puts people with long-term care needs, both seniors and young people with disabilities, in a lower tier of care, and it has many other implications besides a break in the solidarity represented by the single-payer slogan "Everybody in, nobody out." Petty also doesn't mention the heroic fightback against the murderous Graham-Cassidy bill and other attacks on health care by the disability rights organization ADAPT.

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Some consequences of S 1804's treatment of long-term care:

-- People who are born with or acquire permanent disabilities are forced into lifelong severe poverty so that they can qualify for Medicaid; those who are not poor to start with will be reduced to poverty by having to pay for all long-term care services out of pocket.

-- People of color have less wealth to use toward long-term care needs and receive care of lower quality in institutions.

-- People with non-conforming gender and sexuality are at higher risk in institutions where they cannot choose their caregivers.

It appears that states can opt out of federal funds for Medicaid, allowing another Medicaid expansion disaster. Since federal funds are indexed to May 2017 state expenditures, inequities among states will be perpetuated.

Long-term care services will remain uniquely subject to cuts due to federal and state budget balancing maneuvers. Long-term care will remain underfunded, resulting in inadequate pay and benefits for workers, and continuing problems with workforce recruitment and retention.

Some people who recognize this as an issue of great moral and economic significance have begun developing a full single-payer long-term care proposal.Anne Scheetz, MD, Chicago